| NPI | 1104354109 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0001X Radiology, Radiation Oncology (Licence: MA 281654) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MA 271541) |
| Enumeration Date | 2017-06-02 |
| Last Update Date | 2022-05-05 |